Quantitative and objective diagnosis and prognosis of dementia

Imaging & Image Guided Medicine

Wiro Niessen

What are my prospects? Patients with dementia and people with a genetic predisposition for this disease are eager to know what lies ahead of them. An MRI brain scan can contribute to diagnosis as well as prognosis – if the visual data are correctly interpreted.

From June 2016, Quantib BV in Rotterdam is offering radiologists and neurologists software that will help them make a more quantified and objective diagnosis. Quantib’s software is currently integrated for users of GE MRI equipment, explains the company’s Scientific Director, Professor Wiro Niessen. CEO Rudolf Scholte in general comments on spin offs and the difference in culture between academia and enterprise.

Quantib BV, an ISO-certified organisation of twelve people, was established in 2012 as a spin-off from the Biomedical Imaging Group, Rotterdam. This is a research initiative of the Departments of Radiology and Medical Informatics of Erasmus MC. The general idea on which Quantib was founded was similar to the results from the Heartin3D/4D projects: if we can integrate, quantify and visualise a patient's heart condition over time, we can use a similar approach for MRI or CT brain scans. The Quantib method, however, differs quite dramatically from Heartin3D/4D. “On the basis of an MRI brain scan, aspects of the brain, such as the volume of grey matter and white matter are quantified,” explains Wiro Niessen. “And the same goes for potentially existing pathology, such as white-matter lesions or micro-bleedings.”

Reference population

At Quantib, software is developed under a quality system, a requirement for its introduction as a medical device. “The software not only provides a quantification of brain measures, but also uses this as the basis for a quantitative report and visualization, says Niessen. “This enables comparison of an individual patient to a reference population. We’re exploring whether this information can be used for prognosis: will the person attain dementia and when is this process likely to start?”

The possibility of assessing the prognostic value of MR brain images is partly enabled by the data of a Rotterdam Study, a population study in which 15,000 people were followed since 1990. “Thousands of images now allow for a comparison of a patient to the average of this population,” explains Niessen. “These reference data can be used to determine areas in the brain where there are abnormalities, and we are currently exploring the prognostic value of those.”

Commercial aspects

The four years between Quantib starting up and the availability of an operational product is a remarkably short time-to-market. Quantib’s CEO, Rudolf Scholte, emphasises how a start-up's end product generally differs from its academic starting point: “Enterprise and the importance of business administration, marketing, management and financial risk are often underrated in an academic environment. It takes a complex mix of competences, experience and training. Mutual understanding is of the utmost importance – as is some modesty! When society is paying your salary, to what extent is something ‘your’ invention?”

One very important notion is that the invention is not the same thing as the end product. “The invention is only the spark, not the fire,” says Scholte. “A proof of concept or prototype typically has to be rebuilt from scratch to comply with market demands. In our case, code generation had to be completely structured, traceable and controlled. This requires a lot of repetition and testing, which some might find boring. But this corporate approach to medical software is not customary in a research setting. That’s a pity, because it would save time and money, prevent errors and provide leverage during negotiations between the university and commercial parties if such an approach were adopted from the start.”

Gap

This is only one aspect of the gap between academia and the market. “As we have already learned from video recorder systems and PC operating systems, it is often not the technically better product that becomes the most successful one. Start-ups need to realise that commercial aspects shouldn't be underrated,” Scholte advises. “Having said that, it’s true that the connection between academia and enterprise is much closer now than it was some decades ago. One reason for this is the Technology Transfer Offices that are now in place. Furthermore, researchers' successes are nowadays not only measured by their publication scores, but in some places also by their valorisation accomplishments. Still, successful spin-off actions largely depend on the effort of individuals, such as, in the case of Quantib, Professor Krestin, head of Radiology at Erasmus MC.”

There will always remain a difference between the goals of science and those of business, and this creates a difference in culture. “That’s only natural and no big deal, as long as you accept the differences in a team once you’ve started a company,” says Scholte.

The freedom to succeed

In order to further improve valorisation, Scholte paradoxically pleads for more academic freedom. “More freedom and less pressure would result in more commercial success, I'm sure. The brightest minds now have to waste a lot of their time on writing proposals and accounting for every minute. The pressure on scientists has gone over the top since the arguably too-relaxed 1970s were over. Pressure for commercial success shouldn't come on top of that. Awareness of commercial opportunities is great, and everyone has some entrepreneurial sense. But we should also accept that not every scientist will become an entrepreneur.”